Method and apparatus for medical intervention procedure planning

ABSTRACT

An imaging system for use in medical intervention procedure planning includes a medical scanner system for generating a volume of cardiac image data, a data acquisition system for acquiring the volume of cardiac image data, an image generation system for generating a viewable image from the volume of cardiac image data, a database for storing information from the data acquisition and image generation systems, an operator interface system for managing the medical scanner system, the data acquisition system, the image generation system, and the database, and a post-processing system for analyzing the volume of cardiac image data, displaying the viewable image and being responsive to the operator interface system. The operator interface system includes instructions for using the volume of cardiac image data and the viewable image for bi-ventricular pacing planning, atrial fibrillation procedure planning, or atrial flutter procedure planning.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. application Ser.No. 10/065,595 filed Nov. 1, 2002, which is hereby incorporated byreference in its entirety.

BACKGROUND

This invention relates generally to an imaging system, and moreparticularly to a method and apparatus for use of the imaging system inmedical intervention procedure planning.

Medical diagnostic and imaging systems are present in modern health carefacilities. Such systems provide invaluable tools for identifying,diagnosing and treating physical conditions and greatly reduce the needfor surgical diagnostic intervention. In many instances, final diagnosisand treatment proceed only after an attending physician or radiologisthas complemented conventional examinations with detailed images ofrelevant areas and tissues via one or more imaging modalities.

Medical diagnosis and treatment can also be performed by using aninterventional procedure such as congestive heart failure (CHF)intervention. It is estimated that approximately 6-7 million people inthe United States and Europe have CHF. Some patients with CHF alsoexperience left bundle branch block (LBBB), which negatively impacts theelectrical conduction system of the heart. In patients with CHF andLBBB, delayed left ventricular ejection results from delayed ventriculardepolarization, and in the presence of LBBB, ventricular contraction isasymmetrical, which causes ineffective contraction of the leftventricle. Cardiac resynchronization therapy, where both the rightventricle (RV) and left ventricle (LV) are paced simultaneously, hasbeen shown to be effective in improving symptoms in patients with CHFand LBBB. One current clinical treatment for this condition isinterventional bi-ventricular pacing, which involves: positioning RV andright atrial (RA) leads, positioning a sheath in the coronary sinus(CS), performing a CS angiogram to delineate a suitable branch for theLV lead placement, placing the lead for LV pacing in the posterior orlateral branches of the CS, and applying pacing signals to the RV and LVleads to simultaneously pace the RV and LV for synchronization.

Interventional bi-ventricular pacing therapy may involve a lengthyprocedure, may result in unsuccessful lead placement in the CS due tothe CS anatomy, or the lead itself may dislodge from the CS. In mostcases, these situations are identified only at the time of theinterventional procedure, resulting in abandonment of the procedure orthe scheduling of a second procedure where, using a surgical incision,the LV lead is placed epicardially.

BRIEF DESCRIPTION OF THE INVENTION

In one embodiment, an imaging system for use in medical interventionprocedure planning includes a medical scanner system for generating avolume of cardiac image data, a data acquisition system for acquiringthe volume of cardiac image data, an image generation system forgenerating a viewable image from the volume of cardiac image data, adatabase for storing information from the data acquisition and imagegeneration systems, an operator interface system for managing themedical scanner system, the data acquisition system, the imagegeneration system, and the database, and a post-processing system foranalyzing the volume of cardiac image data and displaying the viewableimage and being responsive to the operator interface system. Theoperator interface system includes instructions for using the volume ofcardiac image data and the viewable image for bi-ventricular pacingplanning, atrial fibrillation procedure planning, or atrial flutterprocedure planning.

In another embodiment, a computer system for use in a medicalintervention procedure includes a data port for receiving probeinformation from the medical intervention procedure, a database forstoring information acquired from an interventional procedure planningsession, a memory comprising instructions for managing the probeinformation received at the data port and the stored information in thedatabase, a processor for analyzing the information at the data port incombination with the stored information in the database, an operatorinterface system for managing the memory and the processor, and adisplay responsive to the operator interface for visualizing theinformation in the database in combination with the information at thedata port.

In a further embodiment, a method for generating an image for use inmedical intervention procedure planning includes acquiring a volume ofcardiac image data from a medical scanner, managing the volume ofcardiac image data through segmentation, processing the cardiac imagedata for viewing, viewing the cardiac image data in a viewable image,inserting a geometric marker into the volume of cardiac image data at ananatomical landmark for subsequent visualization, analysis andregistration, selecting a viewable parameter in response to thegeometric marker at the anatomical landmark, and saving a viewableimage, an anatomical landmark, or a measured viewable parameter, in animage database.

In another embodiment, a method for using a volume of cardiac image dataduring a medical interventional procedure includes retrieving aprocedure planning image from an image database, viewing the procedureplanning image, applying a probe into a vessel of a patient during theinterventional procedure, identifying a landmark of the probed vesselfrom the interventional procedure, registering the coordinate system ofthe interventional procedure with the coordinate system of the procedureplanning image, and displaying the procedure planning image in responseto the position of the applied probe for performing a real time vesseltracking procedure on the probed vessel.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the figures, which are exemplary embodiments, andwherein like elements are numbered alike:

FIG. 1 depicts a generalized schematic of an imaging system for use inmedical intervention procedure planning;

FIG. 2 depicts a generalized flowchart of a process for implementing anembodiment of the invention using the imaging system of FIG. 1;

FIG. 3 depicts a flowchart of a process for automatically establishingthe dynamic segmentation threshold value for vessel tracking of thecoronary sinus for both arterial and venous-phase contrast-enhancedstudies in accordance with an embodiment of the invention;

FIG. 4 depicts a flowchart of a process for using the method andapparatus of an embodiment of the invention during an interventionprocedure;

FIG. 5 depicts an immersible view of the coronary sinus origin fromwithin the right atrium generated in accordance with an embodiment ofthe invention; and

FIG. 6 depicts an immersible view within the coronary sinus near theintersection of the coronary sinus and the circumflex generated inaccordance with an embodiment of the invention.

DETAILED DESCRIPTION

A detailed description of an embodiment of the invention is presentedherein by way of exemplification and not limitation with reference toFIGS. 1-3.

FIG. 1 depicts a generalized schematic of an imaging system 100 for usein medical intervention procedure planning, such as, for example,bi-ventricular procedure planning, atrial fibrillation procedureplanning, or atrial flutter procedure planning. The imaging system 100includes: a medical scanner system 110 for generating cardiac imagedata, such as, for example, image data of the right atrium and thecoronary sinus, a data acquisition system 120 for acquiring the cardiacimage data from medical scanner system 110, an acquisition database 130for storing the cardiac image data from data acquisition system 120, animage generation system 140 for generating a viewable image from thecardiac image data stored in acquisition database 130, an image database150 for storing the viewable image from image generation system 140, anoperator interface system 160 for managing the medical scanner system110 and the cardiac image data and viewable image in databases 130, 150,which may be combined into one database, and a post-processing system180 for analyzing and displaying the viewable image in database 150 andbeing responsive to operator interface system 160. Post-processingsoftware in post-processing system 180 includes instructions, and istherefore adapted, to analyze data and display images, therebyconverting post-processing system 180 from a general post-processor intoa specialized post-processor. Scanned data that is capable of beingconverted into a viewable image is referred to herein as image data.

System communication links 210, 212, 216, 218 and database communicationlinks 220, 222 provide a means for signal communication amongst andbetween systems 110, 120, 140, 160, 180 and databases 130, 150.Communication links 210-222 may be hardwired or wireless. Operatorinterface system 160 may be a standalone input/output terminal or acomputer including instructions in a variety of computer languages foruse on a variety of computer platforms, such as, for example, DOS™-basedcomputer systems, Apple™-based computer systems, Windows™-based computersystems, HTML-based computer systems, or the like.

Operator interface system 160 includes a processor 170, such as, forexample, a microprocessor, for managing the medical scanner system 110,for managing the data acquisition and image generation systems 120, 140,for processing and managing the information in acquisition and imagedatabases 130, 150, and for managing the post-processing atpost-processing system 180. Operator interface system 160 also includes:a memory 200 that contains specific instructions relating to a cardiacbi-ventricular pacing planning procedure, user input means, such as, forexample, a keyboard 162, and user output means, such as, for example,displays 164, 166. Display 164 may be adapted for exam prescription, anddisplay 166 may be adapted for visualization. Alternatively, displays164 and 166 may be integrated into one display. Exam prescriptionincludes such input parameters as: scan or region of scan definition,data acquisition control, scanner image control, and the like. Operatorinterface system 160 may also be employed during an actualinterventional procedure to display both interventional procedureplanning images and interventional procedure real-time images, asdiscussed below. During an actual medical interventional procedure, dataport 205 accepts information from a medical probe, such as, for example,a catheter, thereby permitting interventional procedure planning data tobe analyzed in a real-time fashion during the actual interventionalprocedure.

Medical scanner system 110 includes an electrocardiogram (EKG) monitor112 that outputs R-peak events 114, which generally delineate thebeginning of a heart cycle, through an interface board 116 into ascanner 118. The interface board 116 enables synchronization between thescanner data and the EKG monitor data. Alternatively, the interfaceboard 116 may be used to couple the EKG monitor 112 to the scanner 118.An example of an interface board 116 is a Gantry interface board. Theexemplary scanner 118 is a cardiac computed tomography (CT) system withsupport for cardiac imaging, however, the illustrated scanner 118 is forexemplary purposes only; other imaging systems known in the art may alsobe used. Examples of other imaging systems include, but are not limitedto, X-ray systems (including both conventional and digital or digitizedimaging systems), magnetic resonance (MR) systems, positron emissiontomography (PET) systems, ultrasound systems, nuclear medicine systems,and 3D fluoroscopy systems. Medical scanner system 110 also includes EKGgated acquisition or image reconstruction 135 capabilities to image theheart free of motion, typically in its diastolic phase. Medical scannersystem 110 further includes circuitry for acquiring image data and fortransforming the data into a useable form which is then processed tocreate a reconstructed image of features of interest within the patient.The image data acquisition and processing circuitry is often referred toas a “scanner”, regardless of the type of imaging system, because somesort of physical or electronic scanning often occurs in the imagingprocess. The particular components of the system and related circuitrydiffer greatly between imaging systems due to the different physics anddata processing requirements of the different system. However, it willbe appreciated that the present invention can be applied regardless ofthe selection of a particular imaging system.

Data is output from scanner 118 into subsystem 230 that includessoftware to perform data acquisition in data acquisition system 120, andimage generation in image generation system 140. Data control is eitherprovided by operator interface system 160 or within subsystem 230 viacommunication link 212. Data that is output from the scanner 118,including R-peak events 114, is stored in the acquisition database 130.Data acquisition in system 120 is performed according to one or moreacquisition protocols that are optimized for imaging the heart, andspecifically for imaging the right atrium and/or coronary sinus. Imagegeneration in system 140 is performed using one or more optimized 3Dprotocols for automated image segmentation of the CT image dataset,thereby providing an image of the inner surface of the right atriumand/or coronary sinus.

Image data from image generation system 140 is communicated via link 212to operator interface system 160. The image data used by software atoperator interface system 160 for exam prescription and visualization isstored in image database 150. The image data may be archived 167, put onfilm 168 or sent over a network 169 to post-processing system 180 foranalysis and review, including 3D post-processing. The post-processingsoftware used in post-processing system 180 performs segmentation ofcardiac image volume data to extract relevant substructures such as theright atrium and coronary sinus vessel, defining a subvolume or 3D modelof the substructure. The post-processing software also provides 3Drenderings, including immersible (or navigator) views, that is,visualization from the inside, of the right atrium and coronary sinus.These special views can be saved in a 3D rendering file 182, and ageometric model of these structures and substructures can be saved to a3D model file 184, which are saved in image database 150, and may beviewed by the operator of operator interface system 160 during eitherthe medical planning of the intervention procedure or during theinterventional procedure itself, such as in combination with aprojection image during a 3D-fluoroscopy procedure, which isalternatively referred to as an interventional image. In the case of thecoronary sinus, the inner vessel surface is clearly defined in 3Drendering 182 and 3D model 184. The 3D model 184 may include anatomical,or geometric, landmarks, such as, for example, the right atrium,coronary sinus, or thebesian valve, that can be used for 3D registrationof the 3D model 184 with the coordinate system of the respectiveanatomical structures viewed on the operator interface system 160 duringan interventional procedure, thereby enabling concurrent use of the 3Dmodel 184 during a subsequent interventional procedure, such as with aprojection image during a 3D-fluoroscopy procedure. The coordinatesystem relating to the anatomical structures as viewed during aninterventional procedure is referred to as the interventional coordinatesystem. The 3D model 184 can be exported in one of several formats: awire mesh geometric model; a solid geometric model; a set of contoursassociated with each image slice; a segmented volume of binary images; arun-length encoded binary segmentation mask (wherein a segmentation maskis representative of the location of voxels of interest); or a medicaldigital imaging object using a radiation therapy (RT) object standard orsimilar object. Other formats known in the art can also be used to storeand export the 3D models 184. Additionally, the operator can view the 3Drendering and model 182, 184 on a display 186. The 3D renderings cancontain 3D camera information (3D position, view angles, and view-upvector, for example) which specify how the interventional system canrender the 3D model at the same orientation. In another embodiment, theoperator interface system 160 could contain the functions of thepost-processor system 180. In yet another embodiment, display 186 may beintegrated with displays 164 and 166.

The software of post-processing system 180 includes analytical methodsfor performing vessel tracking, which provides the user of operatorinterface system 160 with the capability of analyzing and viewingvarious parameters of the coronary sinus, or another vessel of interest,which include: the diameter and path length of the vessel or vesselsegment, the significant branches of the vessel, the degree of curvature(the degree of bend) of the vessel, and the degree of obstruction withinthe vessel. The ability to perform vessel tracking according to anembodiment of the invention provides the operator with the capability ofperforming an analytical examination during the bi-ventricular pacingplanning procedure without physically entering an analytical probe intothe patient's body. The post-processing software also employs known 3Dmodel manipulation techniques, such as rotation and isometric viewing,to enable the operator to visualize the 3D model, of the CS or itsbranches for example, in different planes, such as cross section views(where the plane is normal to a direction vector positioned on thecenter-line of the vessel) and longitudinal section views (where planein parallel to and includes a segment of the vessel). Thepost-processing software also provides “warped” views of the CS thatinclude a curved reformat view (where the vessel tracking information isprojected onto a single view) and a “lumen view” (where the vessel isstraightened and displayed in one plane for measurement/analysispurposes). The vessel tracking post-processing software also includesthe capability of placing a geometric marker at the centerline of the CSand performing vectorial tracking through the vessel along the vessel'scenterline.

The post-processing software also includes an algorithm forautomatically adjusting the dynamic segmentation threshold value used invessel tracking segmentation such that the coronary sinus can be trackedfor both arterial and venous-phase contrast-enhanced studies. Since theintensity of the voxels within the coronary sinus would be lower forimages from an arterial phase data acquisition, due to the influencethat blood has on the image intensity, the segmentation threshold valuemust be adjusted appropriately in order to obtain correct segmentationimaging. Image brightness is established prior to segmentation and inaccordance with the presence of an arterial or venous-phase study. Thecapability of the post-processing software to automatically distinguishbetween the different image contrasts of an arterial or venous-phasestudy is referred to as contrast-enhanced segmentation analysis, asdiscussed in reference to FIG. 3 below.

Referring now to FIG. 2, a flowchart depicts an exemplary process 300whereby image data created on a cardiac CT is used for medicalintervention planning, and more specifically for bi-ventricular pacingplanning. Exemplary process 300 may be employed in conjunction with theuse of imaging system 100.

The process 300 begins at step 305 where a volume of data is acquired onthe cardiac CT scanner 118 using a protocol that is optimized for theright atrium and/or coronary sinus. An example of a protocol that couldbe used is a vessel imaging protocol that uses a helical scanacquisition technique with gated reconstruction. In an exemplaryembodiment, parameters used by the vessel imaging protocol could include0.5 second Gantry periods with 0.375 helical pitch factors using singleor multi-sector cardiac reconstruction. Parameters could also include120 kilovolts, 250 milliamps, and 1.25 millimeters image thickness on amulti-slice CT scanner. The generation of a volume of data isaccomplished by combining many sequential time slices of scanned data.

At step 310, management of the image dataset is accomplished bysegmenting the data using post-processing software that includes a 3Dprotocol designed to extract data relating to the inner surface of theright atrium and/or coronary sinus. The segmentation of data from adataset refers to the extraction of a specific portion of the datasetthat relates to an anatomical landmark of interest, such as, forexample, the right atrium, the coronary sinus, or an external anatomicalmarker (e.g., a marker external to the patient). Input from an operator,via an operator interface system 160 discussed in reference to FIG. 1,provides the necessary information as to whether the dataset should bemanaged in accordance with a right atrium or coronary sinus algorithm.In an exemplary embodiment, post processing software functions caninclude vessel tracking analysis and the selection of image brightnessthresholds. The data management process at step 310 may require one ormore queues from the operator, during which time the operator may bestepped through the process. These queues typically include, forexample, depositing a point at the origin of the CS and at the distalend of each brach of the CS to facilitate vessel tracking. The 3Dprotocol includes default views for the scanned subject and defaultprocessing steps that can be performed on the image data, therebyproviding an automated procedure for 3D segmentation, visualization,analysis, and exporting. Use of the automated process is managed at theoperator interface system 160 where an operator selects the appropriateautomated procedure to be followed, for example, whether the rightatrium or coronary sinus is to be analyzed.

At step 315, processing of the image data for viewing is performed and a3D model is created.

At step 320, the right atrium and/or coronary sinus is viewed orvisualized using multiplanar volume reformat (MPVR), Maximum IntensityProjection (MIP), 3D surface rendering, or volume rendering (VR), whichmay include an immersible view (i.e., view from the inside). A varietyof 3D software packages are available for cardiac volume analysis andcardiac image quality analysis.

At step 325, the operator inserts a geometric marker, such as, forexample, a sphere, into the volume at an anatomical landmark forsubsequent visualization or analysis. Multiple geometric markers andgeometric landmarks may be inserted and visualized at one time.Geometric landmarks can be visualized in a different color scheme thanthe inner surface of an anatomical landmark, the coronary sinus, forexample. Alternatively, geometric markers can be inserted into thevolume at the geometric landmarks and the coronary sinus can bevisualized in a translucent fashion with the geometric landmarks beingviewed in an opaque fashion. Furthermore, different geometric markerscan be used to identify different anatomical landmarks, therebypermitting multiple volumes to be rendered at different degrees oftranslucency. For example, a model of the heart may be rendered in atranslucent fashion and a model of the CS may be rendered in an opaquefashion, thereby permitting the CS to be viewed in the context of theentire heart. A volume rendering tool such as the one describedpreviously in reference to step 315 can be used to perform this step. Inan exemplary embodiment of the invention, the operator will be steppedthrough the visualization and landmark identification procedure.

At step 330, the operator selects a viewable parameter to be measured orviewed, such as, for example, the diameter of the coronary sinus, thepath length of the coronary sinus, the viewing of significant branchesof the coronary sinus, the quantification of the curvature (the degreeof bend) of the coronary sinus, and the quantification of the degree ofobstruction, stenosis, within the coronary sinus, by selecting ageometric marking associated with an anatomical landmark inserted atstep 325, whereby the post-processing software then calculates theselected parameter and provides a display of the measurement or view.Appropriate 3D renderings for this analysis includes curved reformat andlumen views.

At step 335, specific 3D models or renderings (3D views) that arerequested for visual reference during the medical intervention planningprocedure are saved. Such 3D views may include a viewable cardiac image,an anatomical landmark, or a measured viewable parameter. The 3D viewscould be saved in a variety of manners including industry standardmedical digital imaging images, on film or in a multimedia format. These3D views could also be blended with the projection image on afluoroscopy system. A fluoroscopy system can include positioning anx-ray tube at a precise orientation with respect to the patient and adetector on the other side of the patient in order to get real timex-ray images. The proper orientation is based on the 3D view anglesdetermined during the post-processing analysis where the view angleorientation information is specified in the 3D renderings or in the 3Dmodel itself. A fluoroscopy system is an example of one way to guide acatheter during a procedure.

At step 340, a 3D model of the right atrium and/or coronary sinus isexported using a format of choice to an image database. Possible formatsinclude: a wire mesh geometric model; a solid geometric model; a seriesof contours associated with each image slice; a segmented volume ofbinary images; a run-length encoded binary segmentation mask; and amedical digital imaging object such as the radiation therapy medicaldigital imaging object being used under radiation therapy medicaldigital imaging industry standards. In an exemplary embodiment, allnon-relevant data in the binary images are set to zero and the segmentedvolume of binary images includes only the non-zero information. Thevalue of the voxels correspond to CT attenuation, and the density of atissue expressed in Houndsfield units makes up the segmented volume ofbinary images. In another embodiment, a binary segmentation maskspecifies the location of all relevant voxels within the original volumeitself.

At step 345, the 3D model that has been exported is input into theoperator interface system.

At step 350, the 3D model 184 is registered with the correspondinglandmarks that were identified in step 325. The 3D model 184 can beregistered in the coordinate system of the operator interface systemusing rigid or non-rigid registration techniques. A rigid registrationtechnique typically requires the identification of at least threeanatomical landmarks, whereas a non-rigid registration technique mayrequire the identification of more than three anatomical landmarks. Withrigid registration, the 3D model 184 can be translated or rotated duringan interventional procedure to match up with located landmarks which areimaged or identified by the interventional system. Additional landmarkscan also be used such that a transformation of best fit (in a meansquared error sense) is calculated. The centerline for vessel tracking,near the ostium of the CS for example, can also be used to facilitatethe registration of the 3D model in the interventional system coordinatesystem. With non-rigid registration, the 3D model 184 can also bestretched and warped.

At step 355, the model is further visualized via the operator interfacesystem and selected viewable parameters are mapped onto the model. Theexemplary embodiment described above refers to one 3D model. However,this could be expanded to any number of 3D models being exported by thecardiac imaging system and imported into the operator interface system.

Referring now to FIG. 3, a flowchart of a process 370 for automaticallyestablishing the dynamic segmentation threshold value for vesseltracking of the coronary sinus for both arterial and venous-phasecontrast-enhanced studies in accordance with an embodiment of theinvention is depicted. The algorithm of FIG. 3 is included in thepost-processing software of post-processing system 180.

Process 370 begins at step 375, where the original procedure planning CTvolume data (volume of cardiac image data) is received from imagedatabase 150. At step 380, it is determined, by either comparativemeasurement, image header information, or user input, whether anarterial or a venous-phase contrast-study is under review.

If a venous-phase contrast-study is under review, process logic passesto step 385, where the volume of data is first filtered to remove theheart chamber blood pools. At step 390, the user is prompted for vesseltracking points, such as, for example, a point at the source of the CSand one or more distal points. At step 395, the post-processing softwareperforms a vessel tracking procedure on the CS using vessel trackingmethods discussed herein. At step 400, the tracked CS is visualizedusing curved reformat, lumen view, or navigator view, for example. Atstep 405, the right atrium, previously removed in step 385, isoptionally restored for further visualization and analysis. At step 410,measurements are performed on the vessel or vessel segment, and modeldata is exported as desired.

If at step 380, an arterial-phase contrast-study is under review,process logic passes to step 415, where it is determined, by user input,for example, whether high quality tracking is to be performed. If nohigh quality tracking is to be performed, process logic passes to step420, where a low intensity threshold for CS tracking is selected. Afterstep 420, process logic passes to the block of step 385 and continues asdiscussed above.

If at step 415, it is determined that high quality tracking is to beperformed, process logic passes to step 425 where the volume of data isfirst filtered to remove the heart chamber blood pools. At step 430, theuser is prompted for vessel tracking points for the coronary arteries,such as, for example, a point at the source of the left main artery andoptionally one or more distal points for LAD and LCx. At step 435, thepost-processing software performs a vessel tracking procedure on thecoronary arteries using vessel tracking methods discussed herein. Atstep 440, the high intensity coronary arteries are removed from thevolume. After step 440, process logic passes to the block of step 390and continues as discussed above.

As discussed above and shown generally in the flowchart 450 of FIG. 4,the volume of cardiac image data of a patient captured during aninterventional planning procedure can be retrieved, displayed and usedduring an interventional procedure on the patient. During theinterventional procedure, a probe, such as a catheter, is inserted intothe coronary sinus of the patient and is used to control vessel trackingof the coronary sinus model. To accomplish this real-time vesseltracking, first, a volume of cardiac image data from the interventionalplanning procedure planning is retrieved 460 from the image database,and then segmented (to display the coronary sinus for example) anddisplayed 470. Next, a catheter is inserted 480 into the coronary sinusof the patient, and then a landmark, such as the origin of the coronarysinus, from the interventional procedure is identified 490, therebypermitting registration 500 of the two coordinate systems (i.e., theinterventional procedure planning and the interventional procedurecoordinate systems). Registration 500 includes centerline registration,where the centerline of a vessel, such as the CS, for example, may beused as a geometric landmark. After registration, the procedure planningimage (immersion view of coronary sinus, for example) can be displayed510 in response to the position of the applied probe, thereby permittingreal-time vessel tracking of the coronary sinus. During the real-timevessel tracking intervention procedure, the location of the point of thecatheter can also be displayed along with the procedure planning image,using immersible view, navigation view, volume rendering view, or anyother view discussed herein, thereby facilitating real-time navigationthrough the vessel (for example, coronary sinus). The projection of the3D image, including the current catheter location, can be projectedonto, and combined with, the 3D fluoroscopy image at the same viewingangle.

Referring now to FIGS. 5 and 6, a navigator view of the origin of the CS240 from within the RA and a navigator view within the CS 240 near theintersection of the CS and the circumflex are shown, respectively. FIGS.5 and 6 represent only two instances of a plurality of images createdduring a vessel tracking analysis and were generated in accordance withan embodiment of the invention in the following manner. Using theimaging system 100 of FIG. 1, a volume of cardiac image data wasacquired 305 by medical scanner system 110 using the acquisitionprotocol discussed below. The image data was then segmented 310 toextract out the CS 240 and then processed 315 for 3D model creation andviewing. Vessel tracking of the CS 240 was accomplished in accordancewith the process of FIG. 3, which delineates the steps necessary forappropriate vessel tracking depending on whether a venous-phase orarterial-phase contrast-enhanced study is being analyzed. The resultingvessel tracking images, two depicted in FIGS. 5 and 6, provide theoperator, or physician, with a medical tool that enables viewing of thepatient's actual cardiac anatomy for use during cardiac procedureplanning.

Acquisition Protocol

In reference to FIGS. 5 and 6, a cardiac helical acquisition was usedwith retrospectively EKG-gated reconstruction on a 4/8/16/32+ detectorrow multi-slice scanner. Scanner parameters were set at 120 kv, 300 mA,0.5 sec rotation period, 0.35 helical pitch factor, 1.25 or 0.625 mmslice thickness, with segmented reconstruction at 75% cardiac phaselocation. Scan orientation was from the underside of the heart, and fromthe bottom of the heart towards the top in order to acquire the morecritical data early in the acquisition (considering patient motion,breathing, for example). Prior to the cardiac helical scan, a timingbolus acquisition near the origin of the coronary sinus was performed todetermine the optimal preparation delay (the time between the beginningof contrast injection and the start of the cardiac helical scan).Following the scan and reconstruction of the cardiac images, and wheremotion artifacts were seen in the images, a multiphase reconstructionwas prescribed over the full heart cycle. Phase location was selected ataround 45% where the patient experienced arrhythmia during the scan.Multi-sector reconstruction was employed where motion artifacts werestill seen. The selection of a multi-sector reconstruction procedure maybe facilitated using a multiphase post processing 3D viewer. The mostoptimal set of images (best phase, best reconstruction type, forexample) were selected, and then post processing segmentation wasperformed as defined by the specific 3D protocol for the anatomicallandmark under study (the right atrium, coronary sinus, for example).

Alternatively, two other options are available for acquisition. First,prospectively gated cine acquisitions may be used, or second, a relaxedcardiac gated reconstruction technique (using a phase location toleranceof +/−10% for example) with cardiac gated helical scanning, such thathelical pitch is greater than 0.50, may be used. Both alternativeapproaches allow for less radiation dose to the patient but may affectimage quality due to arrhythmia, for example.

Through bi-ventricular pacing planning in accordance with an embodimentof the invention, interventional bi-ventricular pacing therapy can beplanned out ahead of the actual interventional procedure, and the imagesobtained during the planning procedure can be used during the actualinterventional procedure. By providing the interventionalist withknowledge of the CS anatomy before intervention, an appropriateinterventional procedure suitable for the particular patient can beidentified, thereby improving the efficacy of the interventionalprocedure.

The 3D model can also be used for left ventricle (LV) lead placementduring the interventional procedure. Once the 3D model of the CS hasbeen registered within the interventional system coordinate system, thesystem can provide real time navigation of the LV lead to theappropriate branch of the CS using 3D and immersible (navigator-like)views of the model and the real-time location the of LV lead during theplacement procedure. In a real-time navigation procedure, the vesseltracking images, two instances depicted in FIGS. 5 and 6, are viewed inresponse to the probe, or catheter, being maneuvered during theinterventional procedure. It will be appreciated that the presentinvention is not limited to the analysis of the CS but is alsoapplicable to other volumes of cardiac image data.

While the invention has been described with reference to an exemplaryembodiment, it will be understood by those skilled in the art thatvarious changes may be made and equivalents may be substituted forelements thereof without departing from the scope of the invention. Inaddition, many modifications may be made to adapt a particular situationor material to the teachings of the invention without departing from theessential scope thereof. Therefore, it is intended that the inventionnot be limited to the particular embodiment disclosed as the best modecontemplated for carrying out this invention, but that the inventionwill include all embodiments falling within the scope of the appendedclaims.

1. A computer system for use in a medical intervention procedure,comprising: a data port for receiving probe information and identifiablein information from the medical intervention procedure, the probeinformation relating to a characteristic of a patient's heart, theidentifiable information relating to an identified landmark of a probedvessel from the medical intervention procedure; a database for storinginformation acquired from an interventional procedure planning session;a memory comprising instructions for managing the probe informationreceived at said data port and the stored information in said database;a processor for analyzing the information at said data port incombination with the stored information in said database; an operatorinterface system for managing said memory and said processor; and adisplay responsive to said operator interface for visualizing theinformation in said database in combination with the information at saiddata port.
 2. The computer system of claim 1, further comprising: adisplay responsive to said operator interface for visualizing real-timevessel tracking of at least one of a coronary sinus or a coronaryartery.
 3. A method for using a volume of cardiac image data during amedical interventional procedure, comprising: retrieving at least oneprocedure planning cardiac image from an image database; viewing the atleast one procedure planning cardiac image; applying a probe into acardiac vessel of a patient during the interventional procedure;identifying a landmark of the probed cardiac vessel from theinterventional procedure; inserting a geometric marker into the at leastone procedure planning cardiac image at the identified landmark; usingthe identified landmark and the inserted geometric marker, registeringthe coordinate system of the interventional procedure with thecoordinate system or the at least one procedure planning cardiac image;and displaying the position of the applied probe over the registered atleast one procedure planning cardiac image in order to perform real timevessel tracking and navigation of the probed cardiac vessel.
 4. Themethod for using a volume of cardiac image data set forth in claim 3,wherein said displaying further comprises: displaying a real-time vesseltracking of at least one of a coronary sinus or a coronary artery. 5.The method for using a volume of cardiac image data set forth in claim4, wherein: said applying a probe comprises applying a catheter; andsaid displaying further comprises displaying the location of thecatheter.